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ADHD Medication During Pregnancy and Breastfeeding Women suffering from ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how exposure to ADHD for a long time could affect the foetus. A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders like impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are needed. Risk/Benefit Analysis Pregnant women who use ADHD medications need to balance the benefits of using them against the risks to the fetus. Doctors don't have enough data to make unambiguous recommendations, but can provide information on risks and benefits to assist pregnant women to make informed choices. A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy did not have a greater risk of fetal malformations or structural birth defects. Researchers used a large population-based study of case control to compare the incidence of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was correct and to minimize any bias. The study conducted by the researchers was not without its limitations. The researchers were unable in the beginning, to separate the effects of the medication from the disorder. This limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. The researchers did not examine the long-term effects for the offspring. The study showed that infants whose mothers took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who did not use any medication during pregnancy or quit taking the medication prior to or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy. Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy. Researchers suggest that the small risks posed by the use of ADHD medications during early pregnancies could be offset by the greater benefits to both baby and mother of continued treatment for the woman's disorder. Physicians should speak with their patients about this issue and as much as possible, assist them develop coping skills that can lessen the impact of her disorder in her daily life and relationships. Interactions with Medication Many doctors are faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other doctors, and the research that has been conducted on the subject. The issue of risk for infants can be extremely difficult. Many of the studies on this topic are based on observations rather than controlled research and their findings are often contradictory. The majority of studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. iampsychiatry.uk that is discussed in this journal club addresses these issues by looking at data from both live and deceased births. Conclusion: While some studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. Most studies show a neutral, or even slight negative impact. Therefore, a careful risk/benefit analysis is required in every situation. For a lot of women with ADHD, the decision to stop taking medication can be difficult, if not impossible. In an article published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation and family conflict for those suffering from the disorder. A loss of medication may also affect the ability to drive safely and to perform work-related tasks which are crucial aspects of daily life for those with ADHD. She recommends that women who are unsure about whether or not to discontinue medication due to their pregnancy, consider informing family members, friends and colleagues on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment plan. In addition, educating them can help the woman feel supported when she is struggling with her decision. Certain medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while breastfeeding, it is important to be aware that the drug could be passed on to her infant. Risk of Birth Defects As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about what impact the drugs could have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two massive data sets to examine more than 4.3 million pregnancy and determine if stimulant medication use increased birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was linked to a slightly higher rate of certain heart defects, like ventriculo-septal defects (VSD). The researchers behind the study found no association between early medication use and other congenital anomalies, like facial clefting, or club foot. The results are in agreement with previous studies that have shown the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter half of pregnancy, when a lot of women began to stop taking their medication. Women who used ADHD medication in the first trimester of pregnancy were also more likely to undergo caesarean section, low Apgar score after delivery and a baby who required breathing assistance at birth. However, the authors of the study were unable to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could have contributed to these findings. The researchers hope their study will aid in the clinical decisions of doctors who see pregnant women. The researchers advise that, while discussing risks and benefits are important, the choice on whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements. The authors caution that, while stopping the medication is a possibility to look into, it is not advised due to the high prevalence of depression and mental health issues among women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medication will have a difficult adjustment to life without them once the baby is born. Nursing It can be a challenge becoming a mother. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy. The risk to nursing infant is low because the majority of stimulant medication is absorbed through breast milk in low amounts. However, the rate of exposure to medications by the newborn can vary depending on dosage, frequency it is administered, and the time of the day it is administered. In addition, different medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The impact on a newborn's health is not completely understood. Due to the absence of research, some doctors may recommend stopping stimulant drugs during the course of pregnancy. This is a difficult decision for the woman who must weigh the advantages of continuing her medication against the risks to the foetus. As long as more information is available, doctors may inquire about pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal period. Numerous studies have proven that women can continue to take their ADHD medication safely during pregnancy and while breast-feeding. In the end, more and more patients opt to do this and in consultation with their doctor they have found that the benefits of continuing their current medication exceed any risk. Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also learn about treatment options and strengthen strategies for coping. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration, and, if necessary, adjustments to the medication regimen.